Esterified fatty acid composition

ABSTRACT

The invention is directed to compositions comprising lecithin, olive oil, esterified fatty acids and mixed tocophenols for use in the treatment and prevention of various types of arthritis and other inflammatory joint conditions, periodontal diseases and psoriasis, which avoid many of the side effects associated with known treatments. The compositions of the present invention have the advantage of increased stability, a reduction of arachidonic acid in cells, a reduction in eicosanoid production and enhanced cell regulation and communication. Also disclosed are methods for using the compositions for treatment and prevention.

FIELD OF THE INVENTION

The invention is directed to compositions comprising lecithin, oliveoil, esterified fatty acids and mixed tocophenols for use in thetreatment and prevention of various types of arthritis and otherinflammatory joint conditions, periodontal diseases and psoriasis, whichavoid many of the side effects associated with known treatments. Thecompositions of the present invention have the advantage of increasedstability, a reduction of arachidonic acid in cells, a reduction ineicosanoid production and enhanced cell regulation and communication.Also disclosed are methods of using the compositions for treatment andprevention.

BACKGROUND OF THE INVENTION

More than 400 million people around the world suffer from crippling,chronic pain caused by joint diseases, osteoporosis, spine disorders andmusculoskeletal trauma. Osteoarthritis, the most common type ofarthritis, affects more than 21 million Americans and is a leading causeof disability in the United States. By the year 2020, an estimated 60million people in the U.S. will have some form of arthritis. Besides thephysical toll, arthritis costs the U.S. nearly $65 billion annually.Arthritis is second only to heart disease as a cause of work disability.See MMWR (1999) 48:349–353.

Arthritis usually causes stiffness, pain and fatigue. In some people,only a few joints are affected and the impact may be small. In otherpeople, the entire body system may be affected.

Known therapies for arthritis and inflammatory conditions are usuallypalliative and based on the use of analgesic or anti-inflammatory agentsand physical modalities. Because anti-inflammatories (e.g., NSAIDs)confer potentially high risk for serious NSAID-induced gastrointestinalside effects and renal toxicity, therapies are needed that will beanalgesic, anti-inflammatory, safe and favorably modify the diseasehistory.

The newer class of NSAIDs (e.g. Vioxx™, Celebrex™) are based on theselective inhibition of COX-2. While COX-2 inhibitors have minimizedgastrointestinal complications, they still maintain contraindicationsfor congestive heart failure and renal dysfunction. See Wilcox et al.,Arch. Intern. Med. (1994) 15:42–45; Perneger et al., N Eng J Med (1994)331:1675–1679; and Everts et al., Clin. Rheumatol (2000) 19:331–43.

Thus, there is a serious need for an effective treatment and method ofprevention of arthritis and other rheumatic and skeletal conditions thatdo not cause serious side effects. The present invention providescompositions and methods for treatment and prevention of arthritis andrelated conditions, while avoiding many of the problems associated withcurrent treatments. These compositions have the further benefit ofincreased efficacy and stability and a reduction of arachidonic acid andeicosanoid production in cells.

SUMMARY OF THE INVENTION

The present invention is based on the discovery that the compositions ofthe present invention are effective in the treatment and prevention ofarthritis and other inflammatory disorders but avoid certain sideeffects associated with known treatments, such as renal and cardiacdysfunction. These compositions have the added benefit of increasedefficacy and stability, a reduction of arachidonic acid in cells, areduction in eicosanoid production and enhanced cell regulation andcommunication. The present invention is also effective againstpsoriasis, lupus and heart/cardiovascular disease.

In one aspect, the invention is directed to a composition comprising alecithin fatty acid, an olive oil fatty acid, an esterified fatty acidand mixed tocophenols.

The lecithin fatty acid may be about 1% to about 10% of the composition.Preferably, the lecithin fatty acid is about 1% to about 5% of thecomposition. More preferably, the lecithin fatty acid is about 5% of thecomposition. The olive oil fatty acid may be about 15% to about 25% ofthe composition. Preferably, the olive oil fatty acid is about 15% toabout 20% of the composition. More preferably, the olive oil fatty acidis about 20% of the composition. The esterified fatty acid may be about70% to about 80% of the composition. Preferably, the esterified fattyacid is about 70% to about 75% of the composition. More preferably, theesterified fatty acid is about 74% of the composition. The mixedtocophenols may be about 1% to about 5% of the composition. Preferably,the mixed tocophenols are about 1% to about 3% of the composition. Morepreferably, the mixed tocophenols are about 1% of the composition.

The lecithin fatty acid may include, but is not limited to, palmiticacid, stearic acid, palmitoleic acid, oleic acid, linoleic acid,linolenic acid and mixtures thereof. The olive oil fatty acid mayinclude, but is not limited to, oleic acid, palmitic acid, linoleicacid, stearic acid, arachidic acid, and mixtures thereof. The esterifiedfatty acid may include, but is not limited to, decanoic acid, lauricacid, myristoleic acid, myristic acid, palmitoleic acid, palmitic acid,oleic acid, stearic acid and mixtures thereof.

In a further aspect, the invention is directed to a pharmaceuticalcomposition for treating and/or preventing an arthritis or otherinflammatory joint conditions, psoriasis, lupus, periodontal diseases orheart or cardiovascular condition comprising from about 1% to about 10%of a lecithin fatty acid, from about 15% to about 25% olive oil fattyacid, from about 70% to about 80% of an esterified fatty acid, and about1% to about 5% of a tocophenol, and pharmaceutically appropriatecarriers thereof. The pharmaceutical composition may further comprisesbiocompatable polymers as protective colloids, suspensions or bulkingagents, excipients, binders and carriers, as appropriate.

In a further aspect, the invention is directed to a method of treatingand/or preventing an arthritis or other inflammatory joint conditions,psoriasis, lupus, periodontal diseases or heart or cardiovascularcondition comprising the administration of an effective amount of acomposition comprising a lecithin fatty acid, an olive oil fatty acid,an esterified fatty acid and mixed tocophenols to a subject in needthereof. The arthritis or other inflammatory joint condition mayinclude, but is not limited to, osteoarthritis, ankylosing spondylitis,cervical arthritis, firbromyalgia, osteonecrosis, Paget's Disease,bursitis, psoriasis, gout, carpal tunnel syndrome, juvenile rheumatoidarthritis, lumbosacral arthritis, psoriatic arthritis and rheumatoidarthritis. The subject may be a mammal. Preferably, the mammal is ahuman, canine or feline.

Preferably, the composition is administered topically. When administeredtopically, preferably the amount of the composition administered isabout 1 to 15 mg/kg of body weight of said subject per day. Morepreferably, the amount of the composition administered is about 3 to 10mg/kg of body weight of said subject per day. Most preferably, theamount of the composition administered is about 5 to 8 mg/kg of bodyweight of said subject per day.

The composition is also preferably administered orally. Whenadministered orally, preferably the amount of the compositionadministered is about 5 to 32 mg/kg of body weight of said subject perday. More preferably, the amount of the composition administered isabout 10 to 30 mg/kg of body weight of said subject per day. Mostpreferably, the amount of the composition administered is about 15 to 25mg/kg of body weight of said subject per day. Preferably, thecomposition is administered orally via a soft gel, or alternatively, atablet or capsule.

Preferably, the composition may be administered once a day or twice aday.

In a further aspect, the invention is directed to a method wherein thecomposition is administered to a subject in combination with anothercompound or therapy effective to treat or prevent arthritis or otherinflammatory joint conditions, psoriasis, periodontal diseases, lupus orcardiovascular and heart disease.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS OF THE INVENTION

In general, the terms in the present application are used consistentlywith the manner in which those terms are understood in the art.

By the term “arthritis and other inflammatory joint conditions,” as usedherein, is meant joint inflammation, and refers to more than 100different diseases, including, but not limited to, osteoarthritis,ankylosing spondylitis, cervical arthritis, firbromyalgia,osteonecrosis, Paget's Disease, bursitis, psoriasis, gout, carpal tunnelsyndrome, juvenile rheumatoid arthritis, lumbosacral arthritis,psoriatic arthritis and rheumatoid arthritis. These diseases usuallyaffect the area in or around joints, such as muscles and tendons. Someof these diseases can also affect other parts of the body, including theskin and internal organs.

By the term “topically” is meant application over the afflicted area.For example, the present invention may be applied over the knee joint,or anywhere on the body in order to put the composition into the bloodstream.

By the term “periodontal diseases” is meant any inflammatory conditionresulting in the destruction of the support structure of the dentition.

A. Compositions and Methods of Treatment and Prevention Using Same

The present invention is directed to a composition that is particularlyeffective in the treatment and prevention of arthritis and otherinflammatory joint conditions, as well as psoriasis.

The inflammation process of arthritis involves the release ofpro-inflammatory cytokines (e.g., IL-1β and TNF-α). Fatty acids havebeen shown to affect these inflammatory cytokines in patients withrheumatoid arthritis. It is likely that dietary supplements of thesefatty acids reduce chronic inflammation of rheumatoid arthritis byreducing the release of leukotriene B4 from stimulated neutrophils andof interleukin-1 from monocytes.

Esterified fatty acids (EFA) are fatty acids esterified to cetyl alcoholthat are found in small amounts in ruminant fat reported that ratsinjected with EFA showed greatly increased resistance toadjuvant-induced arthritis. Recently, osteoarthritis patients given EFAshowed significant improvement in quality of life. Thus, EFA has potentphysiological effects. See Curtis et al, J. Biol Chem (2000)275:721–724; and Kremer, Lipids (1996) 31 Supp:5243–47.

Esterified fatty acids (EFA) are well absorbed when given orally ortopically. Most of the EFA are metabolized, with only a small proportionremaining intact in the tissues or plasma. EFA and its metabolitesdistribute to various tissues, such as liver, kidney, muscle, andadipose tissue. The lipid profile of EFA and its metabolites in tissuesis similar between oral and topical administration. The largestproportion of intact EFA are found in the skin tissue at the site oftopical administration.

Thus, the present invention uses an esterified fatty acid formulation.The present formulations are composed of lecithin fatty acids, olive oilfatty acids and esterified fatty acids. The formulations may alsocontain mixed tocophenols. Preferably, the formulations comprise 5%lecithin, 20% olive oil, 74% esterified fatty acids and 1% mixedtocophenols.

In addition to being effective against arthritis and other inflammatoryconditions, the ingredients of the compositions confer other advantages.Specifically, the mixed tocophenols, as a liquid antioxidant, providethe advantage of increased efficacy, stability and preservation to thefatty acid blend. The fatty acid carbons cause a reduction ofarachidonic acid in cells, a reduction in eicosanoid production vialipoxygenase and cyclooxygenase and enhanced cell regulation andcommunication. Tables 1–3 below provide preferred lecithin fatty acids,olive oil fatty acids and esterified fatty acids for use in the presentinvention.

TABLE 1 Lecithin fatty acids Carbons Acid Name Typical % C16:0 palmiticacid 11%  C18:0 stearic acid 4% C16:1 palmitoleic acid 8% C18:1 oleicacid 10%  C18:2 linoleic acid 57%  C18:3 linolenic acid 4% C20–C22various acids 6%

TABLE 2 Olive Oil fatty acids Carbons Acid Name Typical % C18:1 oleicacid 84%  C16:0 palmitic acid 9% C18:2 linoleic acid 4% C18:0 stearicacid 2% C20:0 arachidic acid 1%

TABLE 3 Esterified fatty acids esterified fatty acid molecular acidmolecular Carbons Acid Name Typical % weight weight C10:0 decanoic acid1% 172 396 C12:0 lauric acid 1% 200 424 C14:1 myristoleic acid 25%  226450 C14:0 myristic acid 40%  228 452 C16:1 palmitoleic acid 7% 254 478C16:0 palmitic acid 5% 256 480 C18:1 oleic acid 20%  282 506 C18:0stearic acid 1% 284 508 The most preferred formula blend of the presentinvention is shown in Table 4.

TABLE 4 Preferred formulation blend Compound Typical % lecithin 5% oliveoil 20%  esterified fatty acids 74%  mixed tocophenols 1%

The present invention, whether taken orally or topically, delivers agroup of compounds that are found in limited supply in the normal diet.The primary components not consumed in large amounts are cetyl alcoholand the carbon 14 fatty esters, myristic acid and myristoleate.

These compounds are distributed within the various tissues. Theresulting chylomicrons are then distributed within the circulation andmade available to the entire cellular matrix. In addition, it is verylikely that with both oral and topical use, there is probably somedistribution within tissue spaces prior to the first pass through theliver. One likely pathway is the adipocytokine pathway recently foundwithin the body. The primary compound in this pathway is leptin. Leptinis considered to be involved in the inflammatory process both as aninitiator and as a down regulator.

Fatty acid products can induce alterations in the cellular membrane.Monounsaturated fatty acids similar to those found in the presentinvention have been shown to inhibit endothelial activation and toreduce tissue responsiveness to cytokines. Fatty acids have been shownto regulate a variety of enzymatic processes that regulate chronicinflammatory disease.

Arachidonic acid is one of the primary mediators for inflammation. Fattyacids from fish oil have been shown to decrease the amount ofarachidonic acid in cell membranes reducing eicosanoid production viacyclooxygenase and lipoxygenase. It is the integration betweenarachidonic acid byproducts and their involvement with leukotriene andproglandins that lead to inflammation control. The fatty acids withinthe present invention work to limit eicosanoid production therebyreducing the inflammatory cascade.

There is evidence showing that fatty acids have profound impact oncellular regulation and communication. The primary organs for thisprocess are the endoplasmic reticulum and Golgi body apparatus. Thesetwo cellular structures are the main manufacturers of the cellularsignals within the body. The immediate benefit found with the presentinvention is such rapid cellular communication and regulation.

One area that has great potential is the interplay between the fattyacid compounds of the present invention and sphingolipids. Sphingolipidsare essential for cellular function and are uniquely integrated with theendoplasmic reticulum and Golgi bodies. Sphingolipids are considereddynamic regulators of cellular processes. The variable structure ofsphingolipids and glycerolipids trigger the formation of microdomains orrafts within the membrane. Spingolipids are traditionally based upon aC18 fatty acid backbone, but over 60 different species are known withchain lengths varying from 14 to 20 carbons differing in saturation andhydroxylation.

The influence of dietary manipulation of sphingolipids and glycerolipidsin vitro has demonstrated that stearic acid and EPA can alter theendoplasmic reticulum to Golgi body lipid trafficking compared to oleicacid. One result was an inhibition of ER lipid synthesis and transfer ofmembrane lipids to luminal particles. In addition, the polyunsaturatedfatty acid mediation of T cell inhibition is attributable to signalprotein displacement in membranes. The alteration in lipid rafts is theprimary loci.

The formulation content can be adjusted for pH and isotonicity asneeded, as understood by the skilled artisan. Preferably, the pH rangeis 4.0 to 8.0. These formulations can also include biocompatablepolymers such as polyvinyl pyrrolidone (PVP), polyvinyl alcohol (PVA) orpolyethylene glycol (PEG), and other polymers as protective colloids andsuspension or bulking agents, excipients, binders and carriers, asappropriate.

Well known oral dosage forms that work well with the present inventioninclude pills, tablets, including coated tablets, capsules, gelcapsules, soft gels, elixirs, emulsions, micro-emulsions andpre-emulsion concentrates for controlled or immediate release. Soft gelsare the most preferred oral form. Solubility plays a large role in thedevelopment of oral dosage formulations, because the formulation used todeliver the active drug will affect the amount and/or concentration ofthe drug that reaches the active site over a given period of time. Thecomposition of the formulation also directly affects the solubilizationof the drug compound in the gastrointestinal tract, and consequently theextent and rate of the absorption of the active drug compound into theblood stream. In addition, the therapeutic value of a drug is affectedby the rate in which the drug is released from the delivery systemitself, which in turn affects the rate and extent of solubilization ofthe active compound in the gastrointestinal tract before absorption.

In addition to effectively treating arthritis or other inflammatoryjoint conditions, periodontal disease, psoriasis, lupus orcardiovascular and heart disease, the compositions of the presentinvention are effective at preventing these conditions. In the same waythat fatty acids work within the cell to reduce inflammation, they alsowork within the cell to prevent inflammation from reoccuring. Further,the compositions of the present invention, by reducing and preventinginflammation, prevent the onset of diseases and conditions which resultfrom inflammation. For example, by reducing inflammation of thearteries, the compositions of the present invention prevent occurancesof heart disease and cardiovascular disease.

The appropriate dosage of the composition of the present invention willdepend, for example, on the condition to be treated/prevented, theseverity and course of the condition, whether the composition isadministered for preventive or therapeutic purposes, previous therapy,the patient's clinical history and response to the composition and thediscretion of the attending physician.

Preferably, the composition is administered topically. When administeredtopically, preferably the amount of the composition administered isabout 1 to 15 mg/kg of body weight of said subject per day. Morepreferably, the amount of the composition administered is about 3 to 10mg/kg of body weight of said subject per day. Most preferably, theamount of the composition administered is about 5 to 8 mg/kg of bodyweight of said subject per day. When administered orally, preferably theamount of the composition administered is about 5 to 32 mg/kg of bodyweight of said subject per day. More preferably, the amount of thecomposition administered is about 10 to 30 mg/kg of body weight of saidsubject per day. Most preferably, the amount of the compositionadministered is about 15 to 25 mg/kg of body weight of said subject perday.

The composition is suitably administered to the patient at one time orover a series of treatments, and may be administered to the patient atany time from diagnosis onwards. The composition may be administered asthe sole treatment or in conjunction with other drugs or therapiesuseful in treating and preventing the condition in question.

Thus, in practicing the methods of this invention, the compounds of thisinvention may be used alone or in combination with other therapeuticagents. As used herein, two (or more) agents are said to be administeredin combination when the two agents are administered simultaneously orare administered independently in a fashion such that the agents willact contemporaneously. In certain preferred embodiments, thecompositions of this invention may be co-administered along with othertreatments typically prescribed for these conditions according togenerally accepted medical practice. For example, the compositions ofthis invention can be administered in combination with other therapeuticagents or physical therapies for the treatment and/or prevention ofarthritis or related conditions. Some of the conditions contemplated fortreatment with the present invention, either alone or in combinationwith other known therapies, are provided below. Typical therapies arealso provided, which may be administered in combination with the presentinvention.

Rheumatoid arthritis is characterized by inflammation of the peripheraljoints, potentially resulting in progressive destruction of articularand periarticular structures, with or without generalizedmanifestations. Treatments include NSAIDs, salicylates, gold compounds,cytotoxic or immunosuppressive drugs and corticosteroids.

Ankylosing spondylitis (AS) is categorized as a type of seronegativespondyloarthropathies. Neurologic and cardiological signs canoccasionally result. AS is characterized by mild or moderate flares ofactive spondylitis alternating with periods of almost or totallyinactive inflammation. Treatment includes daily exercise, NSAIDs andcorticosteroids, which have limited therapeutic value.

Osteoarthritis includes marked thickening and proliferation of theanterior longitudinal ligaments. Functional compromise of the vertebralarteries, infarction of the spinal cord, and esophageal compression byosteophytes occasionally occur. Treatment includes acetaminophen orNSAIDs, and may include surgeries such as laminectomy, osteotomy, andtotal joint replacement.

A vascular necrosis occurs in the femoral and humeral heads, the body ofthe talus, and the carpal scaphoid. Posttraumatic avascular necrosisdevelops when blood supply is impaired and is thus a function of therelative contributions of arteries to the femoral or humeral head andthe extent of anastomoses between them, which varies among persons.Treatment includes analgesics, range-of-motion exercise and corticalbone grafts.

Acute infectious arthritis is caused by bacteria or viruses. Neisseriagonorrhoeae is the most common bacterial cause in adults. It spreadsfrom infected mucosal surfaces (i.e., cervix, rectum, pharynx) to thesmall joints of the hands, wrists, elbows, knees and ankles. Chronicinfectious arthritis is caused by mycobacteria, fungi, and some bacteriawith low pathogenicity. Treatment includes antibiotics.

Acute gouty arthritis (gout) may be precipitated by minor trauma,overindulgence in purine-rich food or alcohol, surgery, fatigue,emotional stress, or medical stress (e.g., infection, vascularocclusion). The pain becomes progressively more severe and is oftenexcruciating. Treatments include NSAIDs, colchicine, and lowering theurate concentration in extracellular body fluid.

Osteochondromatosis is characterized by numerous cartilaginous loosebodies in a swollen, painful joint. Surgery is needed to remove theloose bodies along with the synovium of the joint.

Osteoporosis occurs when the amount of bone available for mechanicalsupport of the skeleton eventually falls below the fracture threshold,and the patient may sustain a fracture with little or no trauma. Themajor clinical manifestations of osteoporosis are bone fractures, whichcause chronic pain. Treatment includes pharmaceuticals, maintenance ofadequate body weight, increased walking and other weight-bearingexercises.

Paget's disease is characterized by increased bone density, abnormalarchitecture, cortical thickening, bowing, and overgrowth. Treatment mayinclude salicylates, NSAIDs, orthotics and orthopedic surgery.

Dystonias are sustained muscle contractions that can lead to repetitivetwisting movements and abnormal postures. Torticollis is a chronic,focal dystonia that is different from wryneck, an active, painful,self-limited neck spasm. Treatment includes intensive physical therapy,anticholinergics and benzodiazepines.

Boutonniere Deformity (Buttonhole Deformity) is caused by disruption ofthe central slip attachment base of the middle phalanx extensor tendon,creating a so-called buttonholing of the proximal phalanx between thelateral bands of the extensor tendon. Surgical reconstruction afterfixed deformities develop is often found to be unsatisfactory.

Dupuytren's Contracture (Palmar Fibromatosis) is progressive contractureof the palmarfascial bands, producing flexion deformities of thefingers. Treatment includes local injection of a corticosteroidsuspension into the nodule, surgery and high-dose vitamin E.

Carpal Tunnel Syndrome is the term used to describe a specific group ofsymptoms (tingling, numbness, weakness, or pain) in the fingers or handand occasionally in the lower arm and elbow. These symptoms occur whenthere is pressure on a nerve within the wrist. Treatment often includessurgery.

Sports injuries include lateral and medial epicondylitis (tennis elbow)and patellofemoral pain (runner's knee). The most common cause of muscleor joint injury is overuse. Treatment for almost all acute athleticinjuries includes ice, compression and elevation, as well as localcorticosteroid injections.

Psoriasis is characterized by skin cells that multiply up to 10 timesfaster than normal. As underlying cells reach the skin's surface anddie, their sheer volume causes raised, red patches covered with whitescales. Treatment includes, salicylic acid and steroids.

Lupus is an autoimmune disease that can cause inflammation, pain, andtissue damage throughout the body. Treatment includes anti-inflammatorymedications.

Cardiovascular and heart disease is often characterized by inflammatorylesions throughout the vascular system. Reducing the inflammation of thevascular system can reduce the risk and/or severity ofheart/cardiovascular disease.

Periodontal diseases are comprised of a group of inflammatory conditionsthat result in the destruction of the supporting structure of thedentition, caused by hyperactivated inflammatory conditions. Theactivated condition causes the release of toxic compounds which degradethe surrounding dentition. The regulation of these toxic compounds issimilar to compounds found in most inflammatory conditions derived fromcell membrane oxidation and/or tissue phospholipid liberation. Fattyacids modulate the inflammatory cascade via leukotriene, prostaglandinand thromboxane pathways.

Treatments of periodontal disease includes oral rinse and gum gelscontaining tetracycline, chlorhexidine, doxycycline and minocycline. Itis believed that antibiotic intervention reduces or eliminates theviability of gram-negative and anaerobic bacteria commonly found in themouth cavity. Elimination of the bacterial load retards the developmentof periodontal disease and bone loss. Oral administration of fatty oilselicits a reduction in gingival inflammation. The topical application ofthe compositions and formulations of the present invention canaccomplish similar reductions in bacterial load.

EXAMPLE 1

Bioavailability of EFA Complex

An in vitro experiment was conducted using an esterified fatty acid(EFA) complex, to determine the bioavailablility of the complex inacidic and enzymatic systems replicating stomach and intestinalcontents. An aliquot of the complex was subjected to a pH of 2.0 and topancreatic lipase. The experiment showed negligible amounts of breakdownduring either the low pH or lipase action.

In addition to this in vitro work, rats adapted to a purified diet werefed meals containing 2% of the EFA or no EFA. Two hours later, stomachand small intestine contents were collected and the intestinal mucosascrapped. Lipids were extracted, separated by hydrolysis and evaluatedby the presence of cetyl alcohol. In rats fed a meal without EFA, nocetyl alcohol or EFA was found in any sample. In EFA-fed rats, no cetylalcohol was found in the stomach or intestinal contents or in themucosa, indicating no hydrolysis. However, EFA was found within themucosa, demonstrating absorption.

To further elucidate on the EFA complex bioavailability, the base fattyacid material was cetylated with a labeled cetyl alcohol. The productwas purified and fed to rats normalized on a purified diet. The stomach,intestinal and mucosa contents were again analyzed for hydrolyticby-products. The results demonstrate that about 40% of the EFA complexwas hydroyzed into cetyl alcohol and fatty acids. It was determined thatstomach and intestinal contents, primarily the fat load, determine theamount of hydrolysis of the EFA complex.

Safety of EFA Complex

An oral toxicity study was conducted. Rats were given about 1 teaspoonof the esterified fatty acid complex [via oral gavage]. The results ofthe experiment demonstrated that a dose equal to 1300 times that givento humans elicited no changes in rat behavior and general health, aswell as any abnormalities determined via histology of the major organs(e.g., heart, kidney and liver).

A study was conducted to determine whether the esterified fatty acids intopical cream form induced skin rash or irritation after application forup to 140 days. Nude mice were used. After 140 days of application, thetopical ream did not induce skin rash or irritation, nor did it induceany histological changes in the underlying epidermis.

Efficacy of EFA Complex

The oral soft gel was tested. Subjects were given soft gels daily (6 perday) for a total of 68 days. The two main outcome variables were kneerange of motion and response on the Lequesne Algofunctional Index.Subjects on the active esterified fatty acid oil increased their kneerange of motion by about 10 degrees that was statistically significantfrom the placebo group. In addition, probability estimates from theLequesne Index indicated that active participants achieved statisticallysignificant ability in their functional independence.

EXAMPLE 2

The topical cream was studied. Fourteen subjects suffering frompsoriasis were given a cream, three of which received a placebo.Evaluation at 7 and 14 days showed improvement in pruritis (itching) anda lessoning of psoriasis. The cream also provided improvement inscaling, redness, skin cracking, and inflammation.

EXAMPLE 3

Distribution of Esterified Fatty Acid in Rats After Oral or TopicalAdministration

It was the objective of this study to determine the intestinal andtopical absorption of esterified fatty acids (EFA), its tissuedistribution, and its metabolic form after absorption. Male Wistar rats(10) were divided into two groups. Both groups were fed a standardrodent purified diet (AIN-93G). One group of five rats was gavaged twicedaily with 220,000 DPM of 14C-labelled esterified fatty acids. To theother group of five rats, 220,000 DPM of 14C-labelled esterified fattyacids was applied topically twice a day to an area of shaved skinbetween the shoulders. The fatty acid mixture used in the synthesiscontained various fatty acids, but was enriched in myristoleic acid(25%). After seven days of treatment, the animals were anesthetized withethyl ether, blood was removed by cardiac puncture, and liver, kidney,and sample of muscle tissue from the hind leg were collected, weighed,and frozen. In addition, a two-day fecal collection was made in the lasttwo days of the experiment.

Lipids were extracted from plasma, tissue samples and feces, spotted onto thin layer chromatography plates, and separated into lipid classes.Lipid classes were visualized by exposure to iodine vapor, marked,scraped into liquid scintillation vials, and counted. Apparentintestinal absorption was estimated by determining fecal excretion andsubtracting that from intake, expressed as a percent of intake.Intestinal absorption was virtually complete. Thus, when taken orally,EFA are absorbed to the same high degree as dietary triglycerides.

The distribution of the radiolabel within a tissue was similarregardless of whether the radiolabel was administered orally ortopically. In each tissue examined, the majority of radiolabel was foundin phospholipids or triglycerides. The one exception to this finding wasin adipose tissue from topically applied radiolabel; in this case, asignificant amount of radiolabel was found in the fraction of an unknownlipid. The amount of radiolabel present as intact EFA was relativelysmall in each tissue examined. The amount was greatest in liver, whereis occurred as approximately 6–7% of the radiolabel, and least in kidneyand adipose, where it varied from <1% to 2%.

In the distribution of radiolabel in the small intestinal mucosa of ratsgiven the radiolabel orally, the vast majority of radiolabel was presentin the phospholipid fraction, with little as intact EFA (approximately1%).

The plasma radiolabel distribution among lipid fractions was similar inboth orally and topically administered animals. Again, the majority ofradiolabel was found in the triglyceride and phospholipid fractions.Relatively little intact EFA was present. In both the perirenal fat padand kidney, the amount of radiolabel present was similar for both theorally and topically administered rats. However, in the liver, there wasmuch more radiolabel present from animals given the radiolabel orallythan topically. This would be consistent with oral ingestion, as lipidsabsorbed from the diet are taken up to a high degree by the liver priorto redistribution to other organs.

The profile of radiolabeled lipids in the plasma was similar betweenrats treated orally or topically. Consistent with the findings intissues, the majority of the radiolabel was found in the triglycerideand phospholipid fractions. Only a relatively small amount of radiolabelwas found in the EFA fraction. Thus, regardless of the mode ofadministration, EFA appear to be secreted into plasma primarily as fattyacid esters (e.g., triglycerides, phospholipids, cholesterol esters).

At the site of topical administration, there remained a significantproportion of radiolabel in the EFA form. However, considerableradiolabel appears in the triglyceride fraction, with lesser amounts inphospholipids and cholesterol esters. There was also a large amount ofradiolabel in the unknown lipid fraction.

This study, using a radiolabeled form of esterified fatty acids (EFA),demonstrates that EFA are absorbed when administered either orally ortopically. Intestinal absorption appears to be essentially complete.Based on the similar amounts of radioactivity in adipose and kidney, itis likely that topically absorption is also nearly complete.

From the distribution of the radiolabel amongst the various lipidfraction, it is clear that most EFA are metabolized, with only a smallquantity of EFA remaining intact within the tissues and plasma. In thesynthesis of the radiolabeled EFA, radiolabeled cetyl alcohol was used,so the cetyl alcohol contained the radioactive carbon.

Based on the appearance of radiolabel in the TLC fraction correspondingto cetyl alcohol, it is clear that the EFA are being hydrolyzed to cetylalcohol and fatty acids. Further, the finding of radiolabel in fractionscorresponding to phospholipid, triglyceride, and cholesterol ester,indicates that the cetyl alcohol was oxidized to palmitic acid (andprobably subsequently to other fatty acids). The palmitic acid was thenesterified into phospholipids, triglycerides, and cholesterol esters.

The tissue with the greatest proportion of intact EFA was the liver.This proportion was similar between the oral and topical treatments.This suggests that the liver may be the major site of EFA metabolismi.e., the hydrolysis and subsequent oxidation to fatty acids of thecetyl alcohol occurs largely in the liver, with subsequent export of thefatty acids, as triglyceride.

With topical application, considerable EFA remains in its intact formwithin the skin. However, even here, there is significant metabolism ofEFA into fatty acid, with incorporation into triglyceride, phospholipid,and cholesterol ester. Therefore, the liver may not be the only site ofmetabolism.

Thus, esterified fatty acids are well absorbed when given either orallyor topically. Although a small proportion of esterified fatty acidsremain intact, the vast majority is hydrolyzed and the cetyl alcohol isoxidized to fatty acids and esterified into various types of lipids(e.g., phospholipids, triglycerides, and cholesterol esters).

EXAMPLE 4

The purpose of this investigation was to examine the effects of using atopical cream consisting of esterified fatty acids on pain andfunctional performance in patients diagnosed with osteoarthritis (OA) ofone or both knees. Forty-two patients, 35 women and 7 men, diagnosedwith knee OA were matched and randomly assigned to 1 of 2 topicaltreatment groups: 1) esterified fatty acid (CMC) (N=21; age=61.9±11.9yrs); or 2) placebo (P) group (N=21; age=64.9±10.5 yrs). Patients weretested on 3 occasions: 1) baseline (T1) period prior to cream treatment,2) then after 3 days without treatment, participants applied an initialtreatment to the affected areas and the outcome measures were obtainedafter 30 mm of application (T2), and 3) following a 30-day treatmentperiod consisting of cream application twice per day (T3).

Assessments included knee range of motion (ROM), 40-sec standing centerof pressure (COP) on a force plate to measure postural sway, timedup-and-go from a chair, timed stair climbing ability (up and downsteps), and the single-leg anterior reach (a measure of unilateralstrength and balance). Test-retest reliabilities for all tests rangedfrom 0.95 to 0.99. For stair climbing ability and the up-and-go tests,significant decreases in time were observed at T2 (−1.39 and −0.66 sec,respectively) and T3 (−1.78 and −1.03 sec, respectively) compared to T1in CMC only. These differences were significant between groups(P<0.001). A significant reduction (−0.07 m) was observed for movementof COP during a 40 sec and standing test in CMC only. Supine ROM of theknees increased at T2 and T3 in CMC, whereas no differences wereobserved in the P group. In the single-leg anterior reach, significantimprovements were observed for both legs in CMC and only the left leg inthe P group. However, the improvements observed in CMC weresignificantly greater than the P group for both legs (5.1 and 4.4 cmversus 0.8 and 1.8 cm respectively for the right and left legs). Theseresults indicate that the use of a topical cream containing esterifiedfatty acids is an effective treatment for reducing pain and improvingphysical function in patients with OA. Specifically, patients with OAhad significantly greater ROM of the knee in the supine extended andflexed knee positions, less standing postural sway, improved ability toascend and descend stairs, improved ability to rise from sitting,walking, and sitting down, and greater unilateral balance.

EXAMPLE 5

The effect of a esterified fatty acids for improving the quality of lifeof canines was studied. This study investigated whether esterified fattyacids (EFA) could improve the quality of life (QOL) in arthriticcanines. Small and large breed dogs were enlisted in the studyregardless of current arthritic medication.

Animals were recruited from a veterinary practice in a suburb of SanDiego, Calif. The vet clinic had a sizeable number of canines currentlyunder care for the treatment of joint health disease. The owners readand signed an informed consent. The study was conducted using animalcare guidelines for veterinary practices.

The owners were instructed to bring the dog in for an assessment by theveterinarian. Upon enrollment, the owner completed a medical history andgeneral Quality of Life (QOL) survey. During this time the veterinariangave the pet a physical exam of major body areas and joint structures,which is standard for musculoskeletal disease assessment. Blood andurine were collected with each visit. The dog was given a 30-day supplyof EFA product. The owners were also told to take their dogs on dailywalks lasting from 10 to 20 minutes. The animals were maintained ontheir current medication regimen. The owner then returned with the petafter 30 days for the final physical assessment by the veterinarian andto fill out the QOL survey again.

Esterified Fatty Acid Product

The animal was given dog chews containing a mixture of EFA, dextrates,desiccated liver and hickory flavor. A standard dose of two chews perday per 20 pounds was established.

Quality of Life Survey and Analysis

The survey was filled out at the initial visit and again after 30 daysof supplementation. The owners were asked to write their answers next tothe questions.

Clinical Measures

These measures were taken at the initial visit and again after 30 daysof supplementation. Each dog had blood drawn from the jugular vein witha 22-gauge needle attached to a 6 cc syringe. This is standard practiceto minimize any pain and anxiety the animal might experience in havingit's blood drawn. Experienced, licensed registered veterinarytechnicians drew the blood. The blood was placed in a lavender top tubeand a serum separator tube. The blood in the serum separator tube wasallowed to clot (10 minutes) then spun in a centrifuge. Both tubes wereplaced in the clinical reference laboratory bag (IDEXX VeterinaryServices, Inc. Atlanta, Ga.). The appropriate forms were filled out andthen the entire bag was placed in the refrigerator for transport to theclinical reference laboratory. A standard chemistry 27 panel wasobtained plus a comprehensive CBC.

Urine was obtained by using an ultrasound probe to locate the bladderthen by performing ultrasound-guided cystocentesis or by walking the dogand collecting a “free catch” sample into a sterile collectioncontainer. The urine obtained by either method was placed into a red toptube (no serum separator gel was used) and placed in the IDEXX bag forcollection. The appropriate forms were filled out for the laboratory andplaced in the bag with the urine and the blood. Standard urinebiomarkers were obtained for each collection.

Clinical Analysis

Clinical chemistry tests were performed on Hitachi 747–200® chemistryauto-analyzers using wet reagents. After calibration, normal andabnormal controls were run before each testing sequence, after every 50specimens, and again, after each run sequence to ensure calibrationstability. Quality commercial reagents used were standard to theequipment.

Hematology tests were performed on Abbott Cell-Dyne® 3500 auto-analyzersusing the laser flow cytometry methodology. Hematology results wereverified by several different means including commercial controls,patient controls, pre-assayed standard calibration samples,machine-to-machine comparisons and inter-laboratory comparisons andcontrols run on every shift.

A total of 27 animals were enrolled in the study, 24 animals completedthe study. There were two animals dropped from the study due tononcompliance. One animal was euthanized due to complications unrelatedto the study protocol. Average demographics of the dogs were as follows:Age (yrs)=10.5±2.0; Weight (lbs)=70.4±25.0; and Gender(male/female)=13/11. The average length of time on the study product was32.8±5.7 days.

There were no changes in serum or urine biomarkers after the 30 daysupplementation period. There were a few animals that had some modestimprovement in their gait, but over the clinical evaluation did notuncover any noticeable improvements.

The owners' responses to the questionnaire provided some enlighteninginformation. Owner comments for the QOL survey were very favorable. Eachowner was also asked to write in their own words what they felt wasachieved with the dietary intervention. There was a consistent patternamong participants for improved vitality and function.

The present study demonstrated the benefit of using an EFA supplement asan intervention in the treatment of canines with musculoskeletalconditions. The animals exhibited typical signs and symptoms ofdegenerative joint disease or osteoarthritis. It is worth noting thatmany animals were currently on a standard prescription for treatingtheir malady but were still able to experience improvement. The presentstudy investigated the use of esterified fatty acids for improving QOLin canines of various breeds. The pet owners felt that their animals hadimproved mobility and energy compared to their observations prior to theintervention. While clinical examination did not reveal any noticeabledifferences, it is not uncommon for dogs to “stiffen” when beingevaluated. This serves as a protective mechanism when confronted inunfamiliar environments.

In summary, esterified fatty acids improved the general disposition andfunctional ability in dogs suffering from arthritis. These fatty acidsoffer an alternative to more traditional therapies for treatingarthritis in canines.

TABLE 5 Clinical biomarkers obtained from serum and urine samplesBiomarker Delta Changes White blood cells 0.12 ± 1.8 Neutrophilsegmentation −0.42 ± 11.7 Platelets −23.12 ± 165.4 Absolute Neutrophils 187.0 ± 1872.2 Alkaline phosphate −15.4 ± 76.7 SGPT (ALT) −1.12 ± 39.6SGOT (AST) 0.08 ± 5.5

TABLE 6 Quality of Life Questionnaire Response by Owner Symptom(Question #)* # Dogs with symptom % of Dog Improving Difficulty Rising18 44% Up or Down Stairs 17 47% Sit or Lag on Walks 10 70% MoveSlowly/Stiffly 13 54% Pain During/After Walks 11 64% Limping on Walks 1369% Reduce Stride Length 7 43% Limping 15 67% Difficulty Sitting Down 580% Rear Legs Collapse 8 50% *These are the symptoms with more than 40%improvement.

TABLE 7 Most Common Owner Comments Comment Type* Number GeneralImprovement 10 Improvement in Wanting to Play, Move, 10 ExerciseImprovement in Walking, Limping 9 Improvement in Attitude, Temperament,7 Energy Likes/Wants Supplement 5 *Voluntary written comments by owners

EXAMPLE 6

Periodontitis is a local inflammation that occurs as a result of hostresponse against specific microorganisms and eventually leads to tissuedestruction and systemic complications. The cause of this infectiousdisease is specific Gram-negative microorganisms, such as Porphyromonasgingivalis and Bacteriodes forsythus. While the etiology ofperiodontitis is bacterial, it is clear that the pathogenesis ismediated by the host response.

It has been reported that monosaturated fatty acids inhibit endothelialactivation and reduce tissue responsiveness to cytokines. Fatty acidshave been shown to regulate a variety of enzymatic process thatregulates chronic inflammatory disease. In addition, it has also beenshown that fatty acids can decrease the amount of arachidonic acid incell membranes, reducing eicosanoids production via cyclooxygenase andlipoxygenase. It is the integration between arachidonic acid byproductsand their involvement with leukotriene and prostoglandins that lead toinflammation control. These mechanisms play an important role in thedevelopment of periodontal inflammation. Moreover, high epithelialpenetration ability of fatty acids through gingival epithelium suggeststhat the local application may be favorable in the treatment ofperiodontal inflammation.

Rabbits represent a useful model, in which the physiology and thepathology of periodontal tissues resemble that of humans with respect tothe pro-inflammatory and anti-inflammatory mechanisms. A predictable andreproducible periodontitis can be generated in rabbits by using silkligatures accompanied by the topical application ofperiodontitis-specific microorganism P. gingivalis.

The aim of the study is to investigate the topical application of amonosaturated fatty acid complex (Genepril™) on ligature-inducedperiodontitis model in rabbits. For this purpose, an alreadywell-established model of periodontitis in rabbit jaws will be used,placing silk ligatures around the second premolars with topicalapplication of the periodontitis-specific pathogen Porphyromonasgingivalis. While the first group of animals (test group) will topicallyreceive the fatty acid complex formulated medication, the second group(control group) will receive vehicle alone. After the animals aresacrificed at 6 weeks, histological and radiographical evaluations oftissue specimens will be made. The results of this study will be used tounderstand the local effects of cetylated fatty acids on the gingivaltissues and periodontal disease progression.

Experimental Design

A total of 10 male New-Zealand White rabbits will be equilibrated andhoused. On the day of the experiment, rabbits will be anesthetized usingxylazine (subcutaneous, 0.25 mL) and ketamine (40 mg/kg, IM) and ifnecessary intubated and given isoflurane (1–2.5 MAC). A ligature (3-0braided silk suture) will be placed around the second premolars of bothsides of the mandible. Every other day (Monday, Wednesday and, Friday),animals will be anesthetized using isoflurane to apply the topicalmedications around the ligatures.

P. gingivalis (strain A7436), grown using standard procedures at 109 CFUmixed with carboxy methyl cellulose to form a thick slurry, will beapplied topically to the ligated teeth to induce periodontitis.Following the P. gingivalis application, a test agent or placebo will beapplied topically to the same areas for six weeks. At these times, thesutures will also be checked, and lost or loose sutures will bereplaced. Ethanol will be used as solvent for fatty acid complex.

At the end of the six weeks, animals will be euthanized by Pentobarbitaloverdose (100+mg/kg, W). After euthanasia, the mandible of each rabbitwill be dissected free of muscles and soft tissue, keeping the attachedgingiva intact with the alveolar bone. The mandible will be split intotwo halves from the midline between the central incisors. The left halfwill be taken for morphometric analysis of the bone and the right halfwill be used for histological evaluation of the use of the test andplacebo agents in periodontitis. It is expected that the topicalapplication of a monosaturated fatty acid complex on ligature-inducedperiodontitis model in rabbits will have a positive effect in reducing,treating the periodontitis.

The potential effects of the monosaturated fatty acid complex (cetylatedfatty acids) in the prevention of the periodontal inflammation inducedby the periodontitis-specific microorganism P. gingivalis will bestudied. Experiments will be performed on 10 rabbits for duration of 6weeks. For most of the histological studies, 5–6 animals per group willbe sufficient to show the differences between groups in a p<0.05statistical significance. Because there will be two groups in thisstudy: 1) Test agent group, and 2) Placebo group, 5 animals per groupwill be appropriate for this study (1 test group and 1 placebo group×4animals/group=10 animals).

It is expected that the monosaturated fatty acid complex (cetylatedfatty acids) will have a positive effect in the prevention of theperiodontal inflammation induced by P. gingivalis.

While this invention has been particularly shown and described withreferences to preferred embodiments thereof, it will be understood bythose skilled in the art that various changes in form and details may bemade therein without departing from the spirit and scope of theinvention as defined by the appended claims.

All references discussed above are herein incorporated by reference intheir entirety.

1. A method of treating periodontal disease comprising administering aneffective amount of a composition comprising a cetylated fatty acid anda carrier or an excipient to a subject in need of such treatment,wherein the cetylated fatty acid is selected from the group consistingof cetylated decanoic acid, cetylated lauric acid, cetylated myristicacid, cetylated palmitoleic acid, cetylated oleic acid, and cetylatedstearic acid, and wherein the carrier or excipients is selected from thegroup consisting of lecithin, olive oil, and tocophenol.
 2. The methodof claim 1, wherein the subject is a mammal.
 3. The method of claim 2,wherein the mammal is human.
 4. The method of claim 2, wherein themammal is canine or feline.
 5. The method of claim 1, wherein thecomposition is administered via topical application.
 6. The method ofclaim 5, wherein the amount of the composition administered is about 1to 15 mg/kg of body weight of said subject per day.
 7. The method ofclaim 5, wherein the amount of the composition administered is about 3to 10 mg/kg of body weight of said subject per day.
 8. The method ofclaim 5, wherein the amount of the composition administered is about 5to 8 mg/kg of body weight of said subject per day.
 9. The method ofclaim 1, wherein the composition is administered orally.
 10. The methodof claim 9, wherein the amount of the composition administered is about5 to 32 mg/kg of body weight of said subject per day.
 11. The method ofclaim 9, wherein the amount of the composition administered is about 10to 30 mg/kg of body weight of said subject per day.
 12. The method ofclaim 9, wherein the amount of the composition administered is about 15to 25 mg/kg of body weight of said subject per day.
 13. The method ofclaim 9, wherein the composition is administered via a soft gel.
 14. Themethod of claim 1, wherein the composition is administered once a day.15. The method of claim 1, wherein the composition is administered twicea day.
 16. The method of claim 1, wherein the composition isadministered to a subject in combination with another compound ortherapy effective to treat periodontal disease.
 17. The method of claim1, wherein the carrier or excipient is olive oil.
 18. The method ofclaim 1, wherein the cetylated fatty acid is cetylated myristic acid.19. The method of claim 1, wherein the composition comprises from about1% to about 10% of a lecithin fatty acid.
 20. The method of claim 1,wherein the composition comprises from about 15% to about 25% olive oil.21. The method of claim 1, wherein the composition comprises from about70% to about 80% of an esterified fatty acid.
 22. The method of claim 1,wherein the composition comprises about 1% to about 5% of a tocophenol.23. The method of claim 1, wherein the composition comprises from about1% to about 10% of a lecithin fatty acid, from about 15% to about 25%olive oil fatty acid, from about 70% to about 80% of a cetylated fattyacid, and from about 1% to about 5% of a tocophenol.
 24. The method ofclaim 1, wherein the composition comprises about 74% cetylated fattyacid.
 25. The method of claim 1, wherein the composition comprises about5% lecithin.
 26. The method of claim 1, wherein the compositioncomprises about 20% olive oil.
 27. The method of claim 1, wherein thecomposition comprises about 1% tocophenols.
 28. The method of claim 1,wherein the composition comprises about 5% lecithin, about 20% oliveoil, 74% cetylated fatty acid, and about 1% tocophenols.